| NPI | 1669292272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 253Z00000X In Home Supportive Care | |
| Enumeration Date | 2024-10-16 |
| Last Update Date | 2024-10-16 |